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CTG-Labor and delivery part2

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1)

The CTG shows a baseline rate of 150 beats per minute (bpm). Accelerations are absent and
variability is 7 bpm. There are shallow decelerations occurring with contractions, and the fetal heart
rate is falling by 20 bpm from the baseline and lasting 30 seconds, mirroring each contraction for 80
minutes. Contractions are four every 10 minutes. What is the overall classification?

A 27-year-old low risk primigravida at 38/40 weeks of gestation has rupture of membranes at 5
cm with thick meconium and uterine contractions at a rate of three in 10 minutes. She is
commenced on continuous fetal heart monitoring and a plan is made for re-examination in 4 hours
when she is found to be 6 cm dilated and has a normal CTG. Syntocinon is commenced following
medical review. She is re-examined by the registrar 4 hours after onset of contractions at a rate of 4
in 10 minutes, and she is found to be 6 cm with 2+ caput. The CTG is non-reassuring.

2) What is the next most appropriate next step?

3)

A 25-year-old woman, G1P0, has a BMI of 38. She is at 39+1 weeks of gestation and has had an
uncomplicated pregnancy. She reports a gush of clear fluid 5 hours ago. She is now contracting
strongly, 4 in every 10 minutes.
On examination the fetus is in cephalic presentation with the head 3/5 palpable. Vaginal
examination reveals an effaced cervix, which is 5cm dilated. The head is at station -1 to the spines
with no caput or moulding. The position is not defined and there is clear liquor draining.

Which of the following is the most appropriate method for monitoring the fetus in this stage of
labour?

4)

A low-risk woman in her first pregnancy is in advanced labour. She is progressing well. One hour
previously the cervix was dilated 7 cm and the head was at the spines. She has epidural analgesia for
pain relief. The midwife is concerned about the CTG, and asks for your input.
The CTG shows a baseline rate of 155 bpm and has recorded a sinusoidal pattern for the last 30
minutes.
What is the most appropriate management option?

5)

When evaluated as an adjunct to CTG for intrapartum fetal monitoring, of which outcome has
STAN (ST analysis) been shown to reduce incidence?

6)

. A 36-year-old nulliparous woman in the second stage of labour has been pushing for 30
minutes. The CTG shows a fetal heart rate of 170 bpm, reduced variability and late decelerations
having occurred for the last 25 minutes. Vaginal examination shows the head to be at the ischial
spines in occipitoposterior position.
Which of the following management options would be most appropriate?

A P1 in spontaneous labour at 39+1 weeks of gestation is being monitored by CTG because of
raised blood pressure. She has a history of chronic immune thrombocytopenia. She is 4 cm dilated,
draining clear liquor on admission and progressed to 8 cm in 4 hours. The CTG shows baseline of 145
bpm, variability 60 beats but late decellerations 50% contractions for the last 30 minutes. The
woman has already had IV fluids and a change in position. You are called to review the CTG.

7) What is your first course of action

A woman is admitted for induction of labour at 42 weeks of gestation. After five hours she is
contracting regularly 3 in 10 minutes with an oxytocin infusion of 2 mu/minute. The liquor is stained
with thin meconium and the CTG shows atypical variable decelerations for the last 30 minutes; base
rate 155b/m; variability 10-15 b/m. A vaginal examination reveals a vertex presentation and the
cervix is 5 cm dilated. Which of the following is the most appropriate immediate course of action?

8)  

8)  

8)  

9)

A 19-yr old primigravid woman is admitted to the labour ward in early labour at 41+4 weeks
gestation. She is 1cm dilated and a CTG is commenced. This demonstrates a fetal baseline of 130
bpm, variability 5-15 bpm, acceleration and no deceleration

10)

A woman in her first pregnancy, presents with decreased fetal movements for 24 hours. She is
34 weeks pregnant. A non-stress CTG shows the fetal heart rate is 180 bpm, variability is 3 bpm, and
there have been unprovoked persistent deceler ations for the last 20 minutes.
What is the most appropriate management option?

11)

A registrar is asked to review a prim igravida in labour who has progressed to 6 cm
dilatation and has an abnormal CTG. The registrar reviews the case and confirms that the
CTG has a baseline rate of 1 55bpm, a baseline variability of eight, no accelerations or
decelerations. What ¡s the correct categorisation of this CTG?

12)

29-yr old multiparous woman is admitted to labour ward at 6 cm dilatation at 32 week
gestation. A CTG is commenced and demonstrates a baseline fetal heart reate of 140 bpm with deep
variable decelerations to 60 bpm with slow recovery and normal variability. There is meconium
staining of the liquor. The midwife has tried a change of maternal position for the past 90 mins with
no improvement in the trace.

13)

A 25-year-old G1P0 woman has had an uncomplicated pregnancy. She is currently at 39+1
weeks of gestation and reports a gush of clear fluid 5 hours ago. She is now contracting strongly, 4 in
every 10 minutes.
On examination the fetus is in a cephalic presentation with the head three-fifths palpable. Vaginal
examination reveals an effaced cervix, which is 5 cm dilated. The head is at station –1 to the spines
with no caput or moulding. The position is not defined and there is clear liquor draining.
Which of the following is the most appropriate method for monitoring the fetus in this stage of
labour?

14)

A 32-year-old primigravida is in labour at term. She was started on an oxytocin infusion four
hours previously because of slow progress. There is clear liquor draining. The CTG shows five
contractions every 10 minutes, a baseline rate of 155 bpm, variability of 5-10 bpm, early
decelerations in more than 50% of the contractions, and occasional accelerations for the last 90
minutes. Vaginal examination shows the head to be 1 cm above the ischial spines, in a right
occipitoposterior position, and the cervix is dilated 7 cm. She has progressed 3 cm over the last four
hours.
Which of the following options would be most appropriate for her management?

Your year ST 1 junior colleague wants to know why electronic fetal monitoring (EFM) is the
recommended method of intrapartum fetal surveillance for high-risk pregnancies.

15) What will you tell him?

16)

A 32-year-old woman at 37 weeks in her first pregnancy is admitted for induction of labour as
her baby has ultrasound-confirmed intrauterine growth restriction. In early labour, the CTG shows a
baseline rate of 150 bpm, variability of 5 bpm, and infrequent variable decelerations, dropping from
baseline by 60 bpm or less and taking 60 seconds to recover, recorded over the previous 45 minutes.
She is contracting once every 10 minutes and the cervix is dilated 1 cm and 2 cm long.
What is the most appropriate next step?

A woman with a previous caesarean section is in labour at 39 weeks of gestation. She is 8 cm
dilated. The cardiotocography (CTG) was initially classified as normal. You have now been asked to
review the situation because the
fetal heart rate has acutely dropped from 140 bpm to 70 bpm for 9 minutes, in spite of a left lateral
position. What is the

17) most appropriate course of action?

18)

What proportion of intrapartum CTG with reduced fetal heart rate baseline variability and late
decelerations results in moderate to severe cerebral palsy in children

19)

A 29-year-old para 2 with a booking BMI of 56 presents at 39+3 weeks gestation in labour. She
is found to be 4 cm dilated and contracting 3:10 regularly. The presentation is uncertain, and the
obstetric ST 3 is called to confirm fetal presentation. During the ultrasound the woman has a
spontaneous rupture of membranes. Ultrasound suggests a footling breech presentation. On
examination the woman is dysmorphic looking. Vaginal examination con rms 4 cm dilatation, but
with a cord prolapse, and an emergency call is made. Th e ST 3 anaesthetist and S T7 paediatrician
attend immediately, and the midwife telephones the consultant obstetrician and anaesthetist to
come in from home. T e S 3 anaesthetist is concerned and alerts you to an antenatal assessment
examination that includes Mallampati 3, thyromental distance 5 cm . T e C
Ghasabaselinerateof140,variabilitygreaterthan5,noaccelerations and variable decelerations with fast
recovery lasting less than a minute with every contraction.
What would be the most appropriate immediate course of action?

20)

A 29-year-old para 0 spontaneously labours at 38+3 weeks gestation and at 16:00 she is 5 cm
dilated. At 18:00 decelerations are heard on intermittent auscultation and a C TG is
commenced.Contractionsare 4:10, base rate is 150 bpm variability greater than 5 bpm, there are no
accelerations and there are declarations with every contraction, mostly of greater than 60 bpm and
for greater than 60 seconds. On examination at 18:30 the cervix is 9 cm dilated, and the fetus is
direct occiput anterior at spines. A decision is made for fetal blood sampling.
T hree good samples are taken at 18:40, and the results are lactates of 4.0, 3.9 and 3.8 mmol/L.
What would be the most appropriate course of action?

21)

The CTG shows a baseline rate of 150 bpm and accelerations are present.
Baseline variability is 8 bpm, and there are decelerations, with the fetal heart rate dropping by 50
bpm and lasting 70 seconds. The decelerations start following each contraction for the last 25
minutes in a 40-minute trace. Contraction frequency is four every 10 minutes. What is the overall
categorisation of the CTG?

A primiparous woman at 33+4 weeks of gestation is admitted in labour at 11:30 and was found
to be 3 cm dilated with the fetal head at –2 station. She ruptured membranes, draining clear liquor,
at 13:20. You were called to review the CTG at 14:00: baseline of 150, variability 3, no accelerations
and variable decelerations >60 beats and lasting >60 seconds for last 35 minutes occurring with
almost every contraction. On vaginal examination she was 5 cm dilated and blood-stained liquor was
noted.

22) What is the next most appropriate course of action?

23)

. When evaluated as an adjunct to CTG for intrapartum fetal monitoring ,of which outcome has ST
analysis has been shown to reduce incidence? ?

24)

The CTG shows a baseline rate of 140 bpm Accelerations are absent. Variability has been 3 bpm
for 25 minutes. There are variable decelerations present, each lasting 70 seconds with every
contraction for a duration of 40 minutes, with a delayed recovery and no shouldering. Contractions
are three every 10 minutes. How should the decelerations in the CTG trace be described?

25)

A 28-year-old in her first pregnancy is induced at term plus 10 days. The CTG was normal before
induction of labour; she was dilated 6 cm four hours previously and now is dilated 8 cm on vaginal
examination. She has uterine contractions at a rate of two every 10 minutes. The CTG shows a
baseline rate of 150 bpm, good variability and infrequent shallow variable deceleration.
What is the next most appropriate action?

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